Welcome to Health Talks.
I'm Gail Hogan
and I recently had the pleasure of talking with two Ohio State experts, Dr.
Bodo Knudsen and Dr.
Ganesh Shidham, to answer some questions about kidney stones.
Dr. Shidham, what are kidney stones?
Kidney stones are deposits, hard
deposits of minerals or chemicals in the urine.
They are normally found there,
and they affect up to 10% of the American population.
And they account about half a million
emergency room visits.
They are very common.
And not only they are very common, but they tend to recur.
Are they really stones? Yes.
So they are stones because they are made up
of calcium phosphate, and sometimes occasionally
they could be made of uric acid cystine or struvite.
So they are minerals, so they are classically stones.
But we call them as organic stones, not the stones from the street,
because if you analyze these stones, they can be completely differentiated.
Dr. Knudsen, what is the pain feel like in the beginning
so that someone might know that this is developing?
So extremely severe is one of the signs.
So pain in the side, either on the left or on the right that's really,
really intense, can come out of nowhere, is typical of a kidney stone.
And then as the stone progresses and moves down closer to the bladder,
then sometimes people start
to get urinary symptoms where they feel like they have to go
more often to the bathroom or they get this pressure to go.
Do we know how they form?
So lots of different theories,
but the basics is that these crystals in the urine are getting too concentrated.
And what I like to tell patients is when you take a glass of water
and you put some salt in the water,
if you have a lot of water and a little bit of salt, it's easy to dissolve it.
But if you have a little bit of water and a lot of salt, it's hard to dissolve.
It kind of sticks to the side and forms these crystals.
And that's what happens with stones.
There's not enough fluid
and these crystals stick together and start to form the little rocks. Dr.
Shidham, how does one person get kidney stones and someone else does not? So
most of the
patients who form stones have some risk factors for forming stones.
The risk factors could be as simple as the patient is not drinking
enough water so that he is making very little urine.
That means very concentrated urine.
And when somebody has a very concentrated urine,
it can how high risk for forming stones.
Other could be like that a patient is having very high levels of
calcium, uric acid, oxalates in the urine and they can increase the risk factor.
There could be deficiency of inhibitors
of stone like citrate, that can increase the risk factor.
So there are a number of ways we can identify these risk factors
and that might be responsible for the risk of the stone.
Is a risk factor have to do with age, gender, race, any of those things? In
general, stone is seen in young patients
and I would call the young as 40 to 60.
They are very common.
I agree 40 to 60 is young.
So 40 to 60.
But they are present, can, they can present throughout the age.
It is also remarkable to see that they are most common
in white male population.
So these are the ones which are, I would say, are the most common
as regards age and gender.
Dr. Knudsen, how do we prevent this?
So that's the million dollar question.
But there are some basic things.
So the first one is hydration.
So you really want to drink a lot of fluids, and the more you drink,
the more urine you're going to make and the more
you're going to dilute out those crystals.
And then, you know, the question is, well, how much do you really need to drink?
And the way I look at it, it's not so how much you drink,
but it's how much you urinate or how much you pee after.
You want to be making about two liters over 24 hours.
And that's a lot if you think about it.
If you take a big plastic soda bottle and cut the top off
and I tell you, you got to fill that in 24 hours, that's a lot.
But it's
important to look
at it that way, because if I tell you just to drink two liters a day,
you might go out on a hot day in August and sweat a liter out
and you're only making a liter of urine that way.
So you really have to tailor it to how much you're going to the bathroom.
Well, let's talk about diet, then.
Anything that we eat
would have a good or bad effect on whether or not we develop stones.
Yeah, it can.
So it's interesting.
A lot of the things that we think are typically healthy
and good tends to actually be pretty good for kidney stones.
So generalizations would be lower salt in the diet,
lower sugar in the diet are both good for stones.
Smaller. Good to prevent. Them.
Yeah, good to prevent it. Yeah. Good to prevent. Okay.
Smaller portions of meat.
So a little bit less animal protein can be helpful.
Lots of fruits and vegetables in the diet tends to be a good thing.
But one exception is spinach.
So spinach is extremely high in oxalate,
kind of off the charts high compared to some other things.
So that's one that we usually screen our patients for is how much do they eat?
Because some people eat a spinach salad every day for lunch
and raw has actually got more oxalate than cooked.
So that's one that we try and watch for.
Dr. Shidham, will stress contribute to stones In some people.
Stress indirectly can contribute to stone...
to stones and the reason for that is because patient is stressed
usually may be inclined to eating unhealthy foods,
junk foods, may not be drinking fluids, may not be exercising.
And these all increase the risk for kidney stones.
You mentioned there is some myths regarding kidney stones.
Can you share what those are?
Number one myth, stones can be dissolved.
I would say
very small part is true, but most of that is not true.
The small part is because
very small percent of the patients
do form stones, what are called the uric acid stones and cystine stones.
These stones, if they're small enough, they can be treated by medical management
and that’s truth.
The wrong goes when the patients have calcium stones,
when they have calcium stones, you cannot dissolve them.
They have to be either passed or treated or removed
or blasted by urology and doctors.
Myth number two is avoid calcium in your diet
because your stone is made up of calcium,
and that's perfectly wrong.
There are a number of studies which shows that low calcium diet
increases the risk of kidney stones.
So the recommendation is to
have a
normal calcium in their diet in the form of dairy,
not in the form of supplements like tablets, but in the form of dairy
products and food, which are high in calcium
and the usual dose usually the recommendation for calcium
is 1000 to 1200 milligrams, depending on the age.
Number three, Myth number three, Doctor
Google knows everything.
And it's I see so many patients coming to me
and, tried everything that Internet says and their friends says that or
somebody says and tried those things unfortunately
coming back frustrated and having recurrent stones still.
So there's nothing wrong going on
Internet, studying, looking, educating.
But we need to be careful what the limitations are and what they are.
So I would suggest to get in touch with your healthcare
before you want to start any recommendations that are,
that are online, especially if you want to do it on a long term basis.
Myth number four, cranberry juice helps to prevent stones.
On the contrary, studies have shown that cranberry juice
increases the risk of kidney stones, so they should be avoided
because they have high levels of oxalates
and they make urine acidic.
So, but it has shown,
studies have shown that it prevents urinary tract infections.
So it is okay for patients who have recurrent UTIs
to have cranberry juice, but not for prevention of stones.
Dr. Knudsen How do we get rid of them?
So you have them, now you have to get rid of them.
Yeah, well that's why people come to see me.
So that's my specialty is taking stones out.
The big thing is we've gone from a time where big incisions were made
and they were, you know, long recoveries after surgery
and the exciting thing now is everything is done minimally invasively.
There's almost no stone
we can't get to without some sort of minimally invasive technique.
So you kind of say the days of open surgery for kidney stones are gone.
There's really three main treatment types.
The first one, which has been around since the late 80’s is Shockwave Lithotripsy.
And it used to be a water bath that people went into and sound waves
or shock waves were aimed at the stone through the water bath
to hit the stone, to break it up.
And the stone would break into smaller pieces that the patient would then pass.
Nowadays, the machines are much simpler.
You don't have to go in a water bath anymore.
It's just a machine you lie on.
But the principles are the same.
It really hasn't changed a whole lot.
So that's kind of our first option.
The second option is we go in with a scope and we use a laser to break them up.
All of this is done with the patient asleep, of course,
in the operating room, so they don't see or feel anything.
But the lasers now have become very powerful and can take these
big hard stones and disintegrate them into tiny little particles.
Obviously, you can get them again because you said, well, once
someone has them and then they can have them sometime in the rest of their
life, do you, can you prevent a second, a third, a fourth?
Yes. So
you can or you can help reduce the risk.
But patients ask that, you know, I've had a stone am I going to get another one?
And what I tell them is if you don't change anything, you probably will,
because whatever factors caused that first stone to form are still likely there.
So then it's time to start to focus on making the changes and,
you know, just getting your fluid
intake up a little bit, you know, can certainly help with that.
The way we approach it is
if it's somebody's first stone, they've never had one before,
you know, we start with the basics, you know, more fluid,
look at the overall diet or are there some tweaks we can make,
you know, or were they a big spinach eater?
Can we, can we cut that back?
And then we kind of see how they do.
We follow them for a while.
And if they don't get another stone for a period of time,
then they're hopefully in pretty good shape.
However, if it's the person that you're doing that
and then they're still forming
stones, you know, six months later they're back with another one.
Those are the patients we target for a more kind of sophisticated workup.
And what it involves is we have a team of nephrologists
who work with us in the stone clinic who are experts on stone prevention,
and they'll have the patient get some 24 hour
urine collections where they collect their urine for a couple of days.
And it gets analyzed specifically for stone risk factors.
And the way I look at it, it's
sort of like a blueprint to why they're forming stones.
And then the nephrologist uses that to kind of navigate their risk factors
and start to adjust them, be it with diet medications or other things.
Dr. Shidham, can you explain then why the experts at Ohio State,
your entire department, why
you are so important to patients who have kidney stones?
This division is nationally recognized for its excellent patient
care, in kidney care,
in kidney disease.
Our faculty in this,
in our division are well recognized
and they are experts in various areas of kidney disease.
So a patient with kidney disease can get all the care they need under one roof.
Nephrology has multiple subspecialty clinics
like we have clinics for glomerulonephritis
or vasculitis clinic, what we call as, or we have patients
with polycystic kidney disease.
We have a special clinic for that.
We have a clinic for hypertension, clinic for metabolic stone clinic.
We have clinic for onco nephrology or nephro oncology
where patients have kidney disease because they are exposed to cancer.
Or medications because of cancer, and then we have stones for our clinics
for transplant pre and post transplant.
And of course, we take care of patients with dialysis.
So we have a whole sort of subspecialties
and the
patient can be taken care of under one roof,
not only that, but nephrology has a robust clinical research program
and the patients have an opportunity to enroll in one of those
clinical trials if indicated.
Thank you for watching Health Talks.